The Texas Health and Human Services Commission, which administers Medicaid in Texas for dental braces, has filed a request to be reimbursed for $7.5 million in alleged fraudulent claims it paid to Amarillo orthodontist Dr. Michael Goodwin.

Federal authorities also moved to seize the commercial and personal bank accounts of Dr. Goodwin and his wife as part of a probe linked to a Medicaid fraud scheme, according to the Amarillo Globe-News.

In 2008, Dr. Goodwin became an individual Medicaid provider, which allowed him to bill Medicaid only for services personally provided by the orthodontist.

Soon after the change, the Amarillo orthodontist was reported as scheduling up to 400 Medicaid patients a day and allegedly billing the government for orthodontic treatment he did not perform. The Globe-News further reports that patients and former employees likened the Amarillo Medicaid fraud scheme to “herding cattle.”

In 2009 the Texas Attorney General’s Office’s Medicaid Fraud Control Unit was alerted to the fact that Goodwin was likely billing Medicaid for work done by dental assistants, who worked on dental patients that state law prohibits them from doing “at Goodwin’s direction and without his direct supervision while Goodwin was out of town, away from the office or even while present in the office,” according to an affidavit for the case.

The affidavit further states that Dr.Goodwin scheduled patients in 10-minute increments, “causing pressure for assistants to practice dentistry quickly” and eventually billed Medicaid for their work.

It goes on to outline the fact that Dr. Goodwin would fly from Texas to dental offices in Indiana almost every month, while billing Medicaid for orthodontic patient services in Amarillo on dates when flight records showed he was clearly in Indiana.

The majority of Goodwin’s patients were Medicaid recipients with some reporting that figure could be as high as 95% of his dental practice.

Unfortunately, this is not a new dental braces trend in Texas …

Last June, The Wealthy Dentist reported that in 2010, Texas spent $184 million on Medicaid orthodontics — more than the rest of the United States combined. Dentist Richard Malouf’s All Smiles Dental Centers of Texas collected $5.4 million from Medicaid orthodontics. Since that time, All Smiles’ Medicaid orthodontics billings nearly doubled to $10.2 million.

A new study suggests some truth to this by revealing that, while Invisalign clear orthodontic aligners cost more in materials than conventional edgewise braces, they require fewer patient visits and a shorter duration of treatment for dentists.

Researchers reported this finding at the recent American Association for Dental Research annual meeting, according to Medscape News.

Researchers evaluated the records of 150 dental patients with mild to moderate class I malocclusion. The types of orthodontic procedures were matched for the amount of initial malocclusion and the number of rotated teeth.

According to Medscape News, here’s what they found:

Conventional braces required a median of 13.6 minutes for a routine visit, whereas Invisalign required 9.9 minutes. Emergency, initial, and final appointments were all longer than regular visits.

Conventional braces required about 2.6 more visits than Invisalign, treatment for 2.4 months longer, 1.1 more emergency visits, 9.7 minutes more in chair time, 1.2 minutes more emergency doctor time, and 86.2 minutes more in total chair time.

However, Invisalign cost $500 to $1441 more in materials and required 5.9 minutes more doctor time than conventional braces.

Measuring profitability as fees minus the cost of materials, Invisalign was more profitable than conventional braces, the researchers found, especially for Invisalign providers who are charged $899 in lab costs, a discount that the appliance maker, Align, offers to orthodontists who do more cases.

For these doctors, Invisalign provided about $1000 of profit per hour of chair time with the first $2750 in fees to the patient, rising to $3250 with $6000 in fees. Doctors who are charged $1549 in lab costs by Align had a profit of about $500 with the first $2750 in fees, rising to $3000 with $6000 in fees.

Braces were less profitable overall, starting at $750 per hour of chair time with the first $2750 in fees, but reaching only $2000 with $6000 in fees.

Invisalign is clearly the profit-maker when it comes to adding value to an orthodontist’s practice.

Is the best braces dentist a GP or a specialist? It all depends on who you ask.

Three out of four general dentists think it’s appropriate for GPs to do orthodontics, but a mere 4% of orthodontists surveyed agree. In fact, 41% of orthodontists say they’re the ones who should be doing virtually all ortho work.

“The training is often minimal and results often are not retained,” said one dentist. “I just think it is better to leave the specialties to the specialists.”

Here are some dentist comments on general dentists and orthodontics.

“Case selection is critical and should be based upon the knowledge and skill of the GP.” (Florida dentist)

“Some orthodontists resent GPs doing their own ortho. Why is that? I have never met a single oral surgeon, endodontist, or prosthodontist that had a problem with my practice desires. It could be a matter of greed or pride. You make the call.” (Georgia dentist)

“Would you send your wife to a family physician for her brain surgery?” (Orthodontist)

“As long as they stay within their level of training and they refer when appropriate.” (Texas pediatric dentist)

“The quality of GP ortho is directly related to the quality and quantity of the dental CE. Most GP ortho CE courses are cursory and superficial. Only one or two are a true continuum that mimics an ortho residency.” (Alaska dentist)

“Diagnosis is the most difficult part. Once you have the background, the rest is easy.” (New York dentist)

“With proper training, any GP should be able to perform any procedure, whether it is endo, ortho, dental implants, etc.” (Prosthodontist)

“Every orthodontist is being asked to help or bail out GP cases as they often underestimate the complexity of cases and or are tackling more complex cases than they should due to economic pressures.” (California orthodontist)

“GPs see relapse on a regular basis after ‘specialist’ treatment.” (Maryland dentist)

Dentists love Invisalign, we found in this survey. Three quarters of general dentists say they offer Invisalign braces to their patients.

“You are crazy not to offer this service," advised one doctor. "As a dentist, we do simple cases and refer out to an orthodontist the complex cases. There are lots of dental CE opportunities to beef up your skill sets."

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